The Protecting Medicare and American Farmers from Sequester Cuts Act was signed into law on December 10, 2021. This law addresses the reduction in the 2022 Conversion Factor set by the Physician Final Rule, as reported in my December column, increasing the 2022 Conversion Factor by 3%. The new conversion factor becomes $34.61 compared to $34.89 in 2021. With the increase in Relative Value Units on most E/M codes, the impact to 2022 rates becomes …
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Once You’re in Court, Your Documentation May Be All That Can Save You
Sal D’Allura, DO, FAAFP “It’s lonely being the defendant in a medical malpractice case.” Truer words were never spoken. At some point in our careers, the majority of us will be named in a medical negligence case. The unfortunate reality is that medicolegal issues will arise as a part of our professional lives along with a multitude of negative emotions (which inevitably spill over into our personal lives) when we stand accused. These negative feelings, …
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In Spite of Turbulence, the Forecast Is Sunny for the Urgent Care Market
No one would argue that the past 2 years have been easy for urgent care. First many operations were shut out of the running to receive adequate COVID-19 testing supplies. The same occurred in the early days after vaccine approval. Still, the industry adapted. Once testing supplies were available, operators established new procedures to maximize the number of patients could get tested safely and efficiently, whether that meant setting up in parking lots or selecting …
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Can PAs and NPs Unionize in Urgent Care Settings?
Urgent message: Urgent care’s workforce has changed from primarily emergency physicians to physician assistants and nurse practitioners now making up the bulk of providers. Whereas physicians historically have been excluded from joining a union, recent efforts to organize PAs and NPs have garnered media attention. While just over 10% of U.S. employees belonged to a union in 2019, a number of groups in industries that do not traditionally have a union presence have gone on …
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What’s the Best Policy for Unlocking an Urgent Care’s Doors when a Provider isn’t Present?
Alan A. Ayers, MBA, MAcc is President of Experity Networks and is Senior Editor, Practice Management of The Journal of Urgent Care Medicine. Urgent message: Whether an urgent care must have a provider on-site during all operating hours comes down to the operator’s risk tolerance. As a matter of patient safety, many urgent care centers have adopted a policy that if no provider is on-site, they must lock the doors and refuse entry of any …
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Refunds: How to Avoid Them
Refunds have always been a challenge in healthcare. Not only do they create an administrative burden but there is also the potential for compliance risk. Some common causes for refunds are: Not validating the patient’s insurance eligibility and collecting the wrong copay amount Choosing a blanket amount to collect from all patients up front regardless of whether they have insurance (ie, over collecting at the time of service) Sending statements too early, causing duplicate payments …
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PAs Aren’t Just ‘Assisting’ in Providing Urgent Care
In this issue’s Health Law article, What’s the Best Policy for Unlocking an Urgent Care’s Doors when a Provider Isn’t Present? (page 19), author Alan Ayers, MBA, MAcc points to the capabilities of advanced practice providers as one rationale some urgent care operators use when opting to stay open for business when a physician isn’t present. You could even go a step further and make the argument that the degree of direct care provided by …
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Are Insurance Plans Still Waiving Cost-Sharing?
A common question that I receive is whether COVID-19 testing is still being covered by insurance plans. The Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief, and Economic Security Act (CARES) require insurance plans to cover diagnostic testing without cost-sharing (cost-sharing being the amount assigned to patient responsibility; it includes deductibles, copays, and co-insurance). The word “diagnostic” is significant. COVID-19 testing falls into two categories: Diagnostic – used for treatment. Patients are …
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Considerations for Urgent Care Operators on Equal Pay Legislation and Enforcement
Urgent message: As we see a shift to an overwhelming female workforce in urgent care, it is essential that urgent care operators understand the conditions of, and develop policies to be compliant with, employment laws requiring equal pay among genders. Alan A. Ayers, MBA, MAcc, is President of Experity Networks and is Practice Management Editor of The Journal of Urgent Care Medicine. INTRODUCTION Many urgent care centers already pay the same hourly rate for all …
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Yes, Disparities in Prescribing Exist in Urgent Care—but Which Disparities?
If you read Evaluation of Healthcare Disparities in Urgent Care: A Case Example for Bacterial Pneumonia—see page 23 of this issue—you know that the proportion of appropriate prescriptions written for an on-label medication (in this case, doxycycline for bacterial pneumonia) may differ among various demographic groups. While the conclusions of that study do not necessarily make a cause-and-effect connection, the data should inspire some analysis as to possible rationale for differences for care of various …
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